In response to the COVID-19 pandemic, Congress passed several laws to protect and expand health insurance coverage, including a requirement that states receiving a temporary increase in federal Medicaid funding cannot disenroll people from Medicaid during the public health emergency. This requirement had the potential to improve continuity of coverage, especially in states that had adopted the Affordable Care Act’s Medicaid expansion before the pandemic began.
We used data from the Urban Institute’s Health Reform Monitoring Survey to assess changes between 2019 and 2022 in the share of adults ages 18 to 64 reporting they were insured for the full 12 months before each survey. In March 2019, 83.4 percent of adults reported coverage for all of the past year. This share fell to 82.9 percent in March/April 2020 and remained at that level in April 2021 before rising to 84.2 percent in June 2022. These changes in full-year coverage coincided with a reduction in the share of adults who were uninsured for part but not all of the past year.
We also found an increase in full-year coverage in Medicaid expansion states, from 87.0 percent in 2019 to 88.4 percent in 2022. Full-year coverage did not change significantly in the 12 nonexpansion states: the shares of adults with full-year coverage in these states were 76.4 percent in 2019 and 76.2 percent in 2022.
When the public health emergency ends and states resume processing Medicaid eligibility redeterminations, millions of people will be at risk of losing Medicaid. The size of the resulting change in coverage will depend on state efforts to avoid wrongful terminations of Medicaid and facilitate transitions to other sources of insurance for those who will no longer be eligible.